Medical Claims Manager

4 weeks ago


Miami, United States PayerFusion Full time
Job DescriptionJob Description

Medical Claims Manager

We are looking for a Claims Manager that supervises and manages day-to-day claims operations, including claims evaluation, adjudication and customer service in accordance with agreed quality and production standards. Process claims in a timely manner and complies with industry fair claims practices and applicable state regulations concerning the processing of claims. Sets goals, while being accountable for the results. Manages staff of claims professionals, includes claims examiners, including the regular and timely evaluation of their performance. Maintains good, professional working relationship with superiors, peers, subordinates and other department managers and personnel.

About Us:

We are a service-based company and as a licensed third-party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach.

Duties & Responsibility:

  • Supervise the claims departments to ensure proper workflow is conducted. Monitor timelines and constantly communicate via e-mail with clients to follow up on claims handling.
  • Oversee Claims Examiner Department Responsible for searching the various networks and direct contracts database to determine the appropriate network that a claim should be processed through in order to secure the greatest savings to ensure clients continue to benefit from PayerFusion cost containment efforts. Meets deadlines promised to clients for claims processing.
  • Review and perform quality assessments of work being released to clients to ensure claims processing errors are kept at a minimum. Identify claims that should be audited by the Medical Team when the total charges exceed the pre-established PayerFusion criteria.
  • Coordinate and liaise with other departmental Supervisors as needed to ensure the operational process is followed. Identifies claims where little or no discount is available so that PayerFusion may attempt negotiations on these claims.
  • Implement new procedures for new line of business. Train and cross-train all staff member with the Claims Handling Process and miscellaneous.
  • Review & perform periodic quality assessments of work being released to the clients. Prepare reports as required.
  • Provide clients with daily, weekly and or monthly updates on claims.
  • Train new staff, also cross train existing staff
  • Keep staff current about company, department and organizational issues, in addition to claims eligibility issues or procedures. This will be done via regular departmental meetings, one-on one communications and distribution of written directives.
  • Advise management of any issues raised by staff and suggest actions that will improve processing or resolve the issues. Notify management on eligibility issues.


Knowledge of medical claims coding, different medical specialties and medical services billed for payment by providers to insurance companies is a must.

Bonus Points:

  • PayerFusion provides competitive compensation. Base compensation commences with experience, and knowledge of the claims administration industry.

Benefits

  • Excellent health and dental insurance coverage
  • Free vision, life and hospital gap insurance
  • 12 paid holidays
  • Paid Time Off
  • 401K with company match up to 4%
  • Salary range is commensurate with the experience of the candidate.




  • Miami, United States EDI Staffing Full time

    Our client has an exciting opportunity for a Claims Manager to lead their Claims Department In addition to supervising the Claims personnel, the Manager's primary responsibility will be to ensure accuracy and to achieve cost containment on medical claims for the Company's customersQualified candidates should have experience in a similar role and be able to...


  • Miami, United States EDI Staffing Full time

    Our client has an exciting opportunity for a Claims Manager to lead their Claims DepartmentIn addition to supervising the Claims personnel, the Manager's primary responsibility will be to ensure accuracy and to achieve cost containment on medical claims for the Company's customers Qualified candidates should have experience in a similar role and be able to...


  • Miami, United States EDI Staffing Full time

    Our client has an exciting opportunity for a Claims Manager to lead their Claims DepartmentIn addition to supervising the Claims personnel, the Manager's primary responsibility will be to ensure accuracy and to achieve cost containment on medical claims for the Company's customers Qualified candidates should have experience in a similar role and be able to...

  • Claims Manager

    2 weeks ago


    Miami, United States Staffing Now Full time

    Claims Manager Miami, FL  SNI Companies is seeking an experienced Claims Manager to oversee daily operations in our claims department, ensuring compliance with quality and productivity standardsThis role involves managing a small team, overseeing claim assessments, adjudications, and customer support, while adhering to industry practices and state...


  • Miami, Florida, United States PayerFusion Full time

    Job OverviewAbout PayerFusion:PayerFusion is a premier service-oriented organization dedicated to delivering exceptional administrative solutions. As a licensed third-party administrator, we pride ourselves on attracting top-tier talent to ensure we consistently surpass our clients' expectations. Our innovative approach sets us apart in the healthcare...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Job SummaryCAREERXCHANGE, Inc. is seeking a highly skilled Claims Management Specialist to join our team of professionals. As a Claims Management Specialist, you will play a critical role in managing and resolving a variety of general liability claims, with a particular emphasis on cases involving medical malpractice and other complex scenarios.Key...


  • Miami, Florida, United States King's Insurance Staffing Full time

    Position Overview:King's Insurance Staffing is looking for a dedicated Workers' Compensation Claims Supervisor to lead our claims team in the Northeast Region. This role involves supervising a group of five Claims Examiners who manage both lost time and medical-only claims from initiation to resolution. The supervisor will be tasked with allocating claims to...

  • Medical Claim Analyst

    4 months ago


    Miami, United States Secure Eclaims LLC Full time

    Job DescriptionJob DescriptionReviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries.Performs hospital length of stay reviews to determine reasonable and necessary care, and appropriateness of stay. Recommends appropriate payments of dispute of...


  • Miami Beach, Florida, United States Mount Sinai Medical Center of Florida Full time

    Insurance and Claims Management Specialist Join Mount Sinai Medical Center, a leader in high-quality healthcare. Since its inception, Mount Sinai Medical Center has been dedicated to providing exceptional healthcare services to a diverse community. Our commitment to clinical excellence is reflected in our recruitment and training of top-tier healthcare...


  • Miami, United States Alivi Full time

    Job Title: Revenue Cycle SpecialistWelcome to Alivi's job listing. As a Revenue Cycle Specialist, you will be instrumental in facilitating the efficient processing and resolution of outstanding claims within specified timeframes. Below are the key details of the position:Overview:The main focus of this role is to assess the factors contributing to unresolved...

  • Claims Coordinator

    2 months ago


    Miami Beach, United States Mount Sinai Medical Center of Florida Full time

    Claims and Insurance Coordinator As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across...


  • Miami Beach, United States Mount Sinai Medical Center of Florida Full time

    Claims and Insurance Coordinator As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across...


  • Miami, United States Miami Beach Medical Group Full time

    Job DescriptionJob DescriptionHere at Clinical Care Medical Centers, we are in need of a Billing Manager with in-depth knowledge of Procedural Coding, identifying appropriate ICD-10 coding based on CMS/HCC categories, CPT, HCPS CMS 1500 FORM, HEDIS, MRA, Super Bill, Electronic Claims Submission and Clearing House Operations, EOB and payments, denials and...


  • Miami, United States PayerFusion Full time

    Job DescriptionJob DescriptionAbout Us:We are a service-based company and as a licensed third party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Liability Claims SpecialistLocation: Florida (Hybrid after 90-Day Orientation)Job Type: Full-TimeCompany Overview:CAREERXCHANGE, Inc. is a premier insurance provider focusing on general liability and medical malpractice claims throughout Florida. Our organization is committed to offering extensive risk management solutions while prioritizing exceptional...


  • Miami, Florida, United States EDI Staffing Full time

    Position OverviewEDI Staffing is seeking a skilled Healthcare Claims Supervisor to oversee our Claims Department. This role is pivotal in ensuring precision and cost efficiency in medical claims processing for our clients.Key Responsibilities:Leadership: Direct the claims and repricing teams to maintain optimal workflow.Client Communication: Regularly update...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Liability Claims SpecialistLocation: Florida (Hybrid after 90-Day Orientation)Job Type: Full-TimeCompany Overview:CAREERXCHANGE, Inc. is a premier insurance organization focusing on general liability and medical malpractice claims throughout Florida. Our commitment lies in providing thorough risk management solutions while ensuring outstanding service to our...


  • Miami, Florida, United States AppleOne Full time

    Job DescriptionWe are currently seeking a Claims Operations Supervisor to lead our claims team. This role is essential for overseeing the daily operations of claims processing, ensuring adherence to industry standards and regulatory compliance.Your leadership will play a pivotal role in fostering professional relationships and achieving operational...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Company OverviewCAREERXCHANGE, Inc. is a prominent insurance organization focusing on general liability and medical malpractice claims. We are in search of a proficient General Liability Adjuster with relevant experience.Job Summary:The General Liability Adjuster plays a crucial role in the investigation, assessment, and resolution of general liability...


  • Miami, Florida, United States Insight Global Full time

    Job OverviewInsight Global is seeking a Claims Examination Specialist to join our team. This role involves working in a dynamic environment and offers a contract-to-permanent opportunity with competitive compensation and a flexible first shift schedule.Key Qualifications:High school diploma or GED is mandatory.A minimum of 2 years of experience in medical...